It may help you to know. . .": The early phase qualitative development of a rheumatoid arthritis goal elicitation tool

2021 ◽  
pp. jrheum.201615
Author(s):  
Julie Kahler ◽  
Ginnifer Mastarone ◽  
Rachel Matsumoto ◽  
Danielle ZuZero ◽  
Jacob Dougherty ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Guidelines ◽  
Training Session ◽  
Clinic Visit ◽  
Shared Decision ◽  
Communication Tool ◽  
Group Setting ◽  
Patient Goals

Objective Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. Methods Tool development occurred in three phases: 1) clinician feedback on the initial prototype during a communication training session; 2) semi-structured interviews with RA patients; and 3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. Results Clinicians (n=15) and patients (n=10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool de-emphasizing goals outside of their perceived treatment domain or available resources, highlighted the benefits of the tool to facilitate conversation but raised concern regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and prepare for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. Conclusion A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers, such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher quality care in RA.

scholarly journals Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making (Preprint)

2019 ◽  
Author(s):  
Thomas H Wieringa ◽  
Manuel F Sanchez-Herrera ◽  
Nataly R Espinoza ◽  
Viet-Thi Tran ◽  
Kasey Boehmer
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Chronic Conditions ◽  
Decision Aids ◽  
Multiple Chronic Conditions ◽  
Shared Decision ◽  
Patient Centered ◽  
Patient Goals ◽  
Minimally Disruptive Medicine ◽  
Workload Capacity

UNSTRUCTURED About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.

scholarly journals Perioperative shared decision-making in the Bay of Plenty, New Zealand: Audit results from a complex decision pathway quality improvement initiative using a structured communication tool

2020 ◽  
Vol 48 (6) ◽  
pp. 473-476
Author(s):  
Heidi C Omundsen ◽  
Renee L Franklin ◽  
Vicki L Higson ◽  
Mark S Omundsen ◽  
Jeremy I Rossaak
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Shared Decision Making ◽  
Elective Surgery ◽  
Quality Improvement Initiative ◽  
Health Board ◽  
Shared Decision ◽  
Communication Tool ◽  
Complex Decision ◽  
Structured Communication

Patients presenting for elective surgery in the Bay of Plenty area in New Zealand are increasingly elderly with significant medical comorbidities. For these patients the risk–benefit balance of undergoing surgery can be complex. We recognised the need for a robust shared decision-making pathway within our perioperative medicine service. We describe the setup of a complex decision pathway within our district health board and report on the audit data from our first 49 patients. The complex decision pathway encourages surgeons to identify high-risk patients who will benefit from shared decision-making, manages input from multiple specialists as needed with excellent communication between those specialists, and provides a patient-centred approach to decision-making using a structured communication tool.

scholarly journals English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

2014 ◽  
Vol 41 (7) ◽  
pp. 1290-1297 ◽  
Author(s):  
Jennifer L. Barton ◽  
Laura Trupin ◽  
Chris Tonner ◽  
John Imboden ◽  
Patricia Katz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Language Proficiency ◽  
English Language ◽  
English Language Proficiency ◽  
Shared Decision ◽  
Limited Health Literacy ◽  
Limited Health

Objective.Treat-to-target guidelines promote shared decision making (SDM) in rheumatoid arthritis (RA). Also, because of high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision making in 2 cohorts of adults with RA.Methods.Data were derived from patients enrolled in 1 of 2 longitudinal, observational cohorts [University of California, San Francisco (UCSF) RA Cohort and RA Panel Cohort]. Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately.Results.Of 509 patients across 2 cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel Cohort.Conclusion.This study of over 500 adults with RA from 2 demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the RA Panel Cohort. These findings underscore the need to examine the influence of SDM on health outcomes in RA.

Decision dissonance/alignment scale to promote patient-centered decisions about urinary diversion with cystectomy for bladder cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16010-e16010 ◽  
Author(s):  
Scott Michael Gilbert ◽  
Michael C Leo ◽  
Christopher Wendel ◽  
Robert S. Krouse ◽  
Marcia Grant ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Urinary Diversion ◽  
Convergent Validity ◽  
Shared Decision ◽  
Patient Centered ◽  
Kaiser Permanente ◽  
Decision Style ◽  
Patient Goals ◽  
Patient Values

e16010 Background: The choice of urinary diversion (UD) with cystectomy is an opportunity to provide preference-driven care. We adapted a decision dissonance scale to measure concordance of patient goals with choice of ileal conduit (IC) vs. neobladder (NB) UD. Methods: With patient and clinician input, we identified 6 IC- and 4 NB-aligned goals, each rated on an 11-point scale (0 = not at all important to 10 = very important). Kaiser Permanente members rated the importance of these goals in a comprehensive survey mailed 6 months post-op (71% response rate (269/381)). Excluding respondents (n=93) with contraindications to NB and missing data on goals, we examined structural validity with principal axis factor analysis and convergent validity using correlations with other decision-making measures. Results: Items aligned to IC vs. NB factored separately as hypothesized (Table 1). NB patients prioritized (p<.05) NB-aligned goals (M=8.8, SD=1.8) over NB-dissonant goals (M=4.3, SD=2.4). IC patients’ alignment (M=5.4, SD=2.7) and dissonance (M=5.6, SD=2.1) ratings were similar. Dissonance was negatively correlated with informed decision-making (r=-.27) and satisfaction with care (r=-.21), and positively correlated with decision regret (r=.28) (each p<.01), but not correlated with shared decision making or decision style preference. Alignment was not significantly correlated with decision-making measures. Conclusions: Our measure distinguished patient values that could guide shared decision-making about UD choice. Patients who chose a NB had strong preferences for maintaining body integrity and function. [Table: see text]

Use of a patient-preferences shared-decision-making encounter tool in clinical practice for patients with non-Hodgkin’s lymphoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24192-e24192
Author(s):  
Debra Wujcik ◽  
Amitkumar N. Mehta ◽  
Rachel Corona ◽  
Felice Cook ◽  
Matthew Dudley ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Medical Science ◽  
Patient Activation ◽  
The United States ◽  
Molecular Profile ◽  
Shared Decision ◽  
Goals Of Care ◽  
Patient Goals

e24192 Background: Non-Hodgkin lymphoma (NHL) is the fourth leading cause of cancer in the United States with 77,240 new cases and 19,940 deaths annually. Treatment options are numerous and driven by patient’s molecular profile, risk, preferences/goals, and ability to tolerate treatment. Aligning physician-patient goals of care and integrating patient preferences into a shared-decision making (SDM) model allows patients and providers to select treatment consistent with medical science and personalized to each patient. This project evaluates feasibility of a patient preferences (PP) SDM encounter tool using technology to facilitate SDM at treatment decision (TD) for patients with NHL. Methods: To date, 45 patients with NHL at a TD making point were recruited from two sites to complete a tablet-based PPSDM encounter tool. The tool includes questions about needs, decision making preferences, values and goals of care. Results are reviewed by the provider and used to facilitate SDM in treatment selection during the clinical encounter. Patients also completed measures to assess satisfaction with the TD, patient activation, and perceived achievement of desired role in SDM at 3 weeks and 3 months post TD. Results: Participants are mean age 66 years (range 23-86), 53% male, and 98% white. 47% (n = 45) preferred that their doctor share responsibility with them when deciding which treatment was best for them. 69% said they would like to make the TD together with family and close friends and 69% agreed that their spouse was the most important person in helping make a TD. 51% said spirituality did not play a part in their TD. When asked how they liked to get medical information, 67% said they wanted all the facts, but not the prognosis. 87% said they had identified a medical surrogate to make decisions, yet 31% had an advanced directive on file. 64% agreed their cancer was curable and 84% agreed that a treatment goal was to get rid of all cancer. 73% of providers used the PPSDM results in conversation with the patient and 53% indicated their patient management changed based on the PPSDM results. There was 24% concordance between patient and provider perception of how TD were made. Conclusions: Collecting patient preferences, values, and care goals prior to the clinical visit using technology is feasible in busy clinics. Although most providers used the PPSDM results and over half changed their management plan, there was low concordance between patient and provider perceptions. Final analysis will include 3 week and 3 month measures of patient activation and satisfaction.

scholarly journals Much to do with nothing: microsimulation study on time management in primary care

BMJ ◽  
2018 ◽  
pp. k4983 ◽  
Author(s):  
Tanner J Caverly ◽  
Rodney A Hayward ◽  
James F Burke
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
General Practitioners ◽  
Preventive Care ◽  
Time Management ◽  
Clinic Visit ◽  
Shared Decision ◽  
Personal Time ◽  
Time Space

Abstract Objective To investigate the credibility of claims that general practitioners lack time for shared decision making and preventive care. Design Monte Carlo microsimulation study. Setting Primary care, United States. Participants Sample of general practitioners (n=1000) representative of annual work hours and patient panel size (n=2000 patients) in the US, derived from the National Health and Nutrition Examination Survey. Main outcome measures The primary outcome was the time needed to deliver shared decision making for highly recommended preventive interventions in relation to time available for preventive care—the prevention-time-space-deficit (ie, time-space needed by doctor exceeding the time-space available). Results On average, general practitioners have 29 minutes each workday to discuss preventive care services (just over two minutes for each clinic visit) with patients, but they need about 6.1 hours to complete shared decision making for preventive care. 100% of the study sample experienced a prevention-time-space-deficit (mean deficit 5.6 h/day) even given conservative (ie, absurdly wishful) time estimates for shared decision making. However, this time deficit could be easily overcome by reducing personal time and shifting gains to work tasks. For example, general practitioners could reduce the frequency of bathroom breaks to every other day and skip time with older children who don’t like them much anyway. Conclusions This study confirms a widely held suspicion that general practitioners waste valuable time on “personal care” activities. Primary care overlords, once informed about the extent of this vast reservoir of personal time, can start testing methods to “persuade” general practitioners to reallocate more personal time toward bulging clinical demands.

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